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Crucial Factors Influencing Health & Recovery in Musculoskeletal Care

presented by Chad Cook, PT, PhD, MBA, FAPTA, FAAOMPT

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Disclosure Statement:

Financial: Chad Cook receives compensation from MedBridge for this course. He also is a research consultant for Hawkins Foundation of the Carolinas. Chad Cook receives royalties from Pearson education, Maitland Australian Physiotherapy Association, AgenceEBP, and is a paid associate editor for JOSPT.

Non-Financial: Chad Cook is a senior associate editor for BJSM and is an editorial board member for J Physiotherapy and JMMT.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 90 Minutes; Learning Assessment Time: 63 Minutes

Worldwide, musculoskeletal (MSK) disorders are the second most common cause of disability, having increased by 45% from 1990 to 2010. Chronic MSK conditions continue to worsen, and despite millions of dollars in research and thousands of review and guidelines articles, patient-reported outcomes for those with musculoskeletal injuries have worsened over the last 15 years. We now recognize that our lack of progress in achieving better treatment results is rooted in the fact that we have failed to focus on identifying and addressing the factors that really do influence patients' outcomes. Evidence suggests that recovery from poor health or injury occurs by multidimensional means and that examination and treatment methods should reflect these dimensions. Recent work has outlined five critical assessment domains for addressing pain and disability: 1) nociceptive pain elements, 2) neuropathic pain elements, 3) comorbidities and severe mental health disorders, 4) moods and cognitions, and 5) social and environmental factors. This course addresses the constructs of each of these domains and discusses the best examination topics for each, and it reflects on recovery for patients regardless of acuity of symptoms. Health care practitioners, regardless of background, are targeted within the course topics.

Meet Your Instructor

Chad Cook, PT, PhD, MBA, FAPTA, FAAOMPT

Chad Cook, PT, PhD, MBA, FAPTA, FAAOMPT, is a professor at Duke University and the program director of the Doctor of Physical Therapy division with a Category A appointment in the Duke Clinical Research Institute. He is a clinical researcher, physical therapist, and profession advocate with a long-term history of clinical care excellence and service…

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Chapters & Learning Objectives

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1. Our Outcomes Are Worsening: Why?

Musculoskeletal disorders are the second most common cause of disability. Chronic conditions continue to worsen, and despite millions of dollars in research and thousands of review and guidelines articles, patient-reported outcomes for those with musculoskeletal injuries have worsened. We now recognize that our lack of progress in achieving better treatment results is rooted in the fact that we have failed to focus on identifying and addressing the factors that really do influence patients’ outcomes. This chapter outlines why our outcomes have worsened and what domains are necessary to assess for better outcomes.

2. The Pain and Disability Drivers Model

The Pain and Disability Drivers model was created to give clinicians an understanding of which domains influence pain and disability. Five domains are discussed: nociceptive, neuropathic, comorbidity, cognitive-emotional, and social/environmental. Within the five domains, learners will be exposed to subclassifications of conditions that influence severity. Interactions among domains is also discussed.

3. Nociceptive Pain Drivers

Nociception and pain are two distinct components. Nociception is the sensory nervous system's response to certain harmful or potentially harmful stimuli. On the other hand, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Nociception can cause the pain experience and is deserving of assessment. In this chapter, we describe key nociceptive triggers and associative examination methods for each.

4. Neuropathic Pain Drivers

Neuropathic pain arises as a direct consequence of a lesion or disease affecting the nerves or nervous system. Neuropathic pain may be associated with radiculopathy, myelopathy, and peripheral and/or central nervous system hypersensitivity. In this chapter, we describe the key neuropathic descriptors, tests, and measures used for assessment.

5. Comorbidity Pain and Disability Drivers

It is well described that comorbidities, sleep hygiene, and severe mental health illness are responsible for mediating health outcomes or worsening outcomes. These factors may influence both pain and disability. Conditions such as osteoarthritis are expected to continue to rise with an increasingly obese, sedentary, and aging population. Standard measurement of these factors should be as principal in a clinical examination as measuring vital signs. In this chapter, we describe key associative examination methods for each.

6. Cognitive and Emotional Pain and Disability Drivers

Much research has gone into understanding how moods and cognitions influence pain and disability outcomes. In fact, more than 5,200 peer-reviewed articles per year are published on this specific topic. Moods and cognitions can elicit a pain experience and can mediate outcomes. Moods and cognitions are particularly important when behaviors are changed in the individual. In this chapter, we describe key associative examination methods for cognitions and moods that influence pain and disability. We also discuss the challenges of medicalization of moods and how to reduce this risk in practice.

7. Social and Environmental Disability Drivers

Social and environment factors remain the strongest and most elusive of outcomes mediators and moderators. Commonly called "social determinants of health," social and environmental factors can influence outcomes and health-related disability. There is a significant challenge associated with how to measure these factors. In this chapter, we describe key associative examination methods that are transferable for all cultures and populations.

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